Proefschrift

Introduction 11 surgeon.19 For peri- or intra-articular fractures, the recommended protocols include 612 weeks of non-weight bearing, after which a gradual increase to full weight bearing is recommended.2 This restricted weight-bearing (RWB) strategy is thought to limit the forces at the fracture site and the implant and reduce the risk of mal-reduction. In light of the possible implications of early weight-bearing Haller et al. reviewed a number of studies investigating earlier weight bearing compared to standard, time-restraint weight bearing in tibial plateau, tibia plafond, ankle, and calcaneal fractures and found no increase in complication rate.20 Especially a number of randomized controlled trials in ankle fractures provide compelling evidence for early weight bearing although the early weight bearing groups received additional plaster immobilisation for stabilization. As reported in a randomized controlled trial dealing with fractures of the ankle joint, early weight bearing does not pose an undue risk of complications or worse patient outcomes compared to a non-weight bearing protocol.21 Furthermore, a meta-analysis shows that following ankle surgery early weight-bearing tends to accelerate return to work and daily activities compared to late weight-bearing without higher risk of complications.22 Postoperative rehabilitation for tibial plateau fractures most commonly involves a significant period of non-weight bearing before full weight bearing is recommended at 8-12 weeks. A study by Solomon shows that, in tibial plateau fractures, internal fixation with subchondral screws and a buttress plate provided adequate stability to allow immediate post-operative partial weight-bearing, without harmful consequences.23 Thus, the type of rehabilitation may be an important factor influencing recovery, necessitating future high quality prospective studies to determine the impact of different protocols on clinical and radiological outcomes.24 The standard aftercare treatment in surgically treated trauma patients with fractures of the tibial plateau features is non- or partial weight bearing.2 According to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) principles of fracture management, postoperative management of (peri-) or intra-articular fractures of the lower extremities generally consists of toe-touch weight bearing for 6–12 weeks.2 As to fractures caused by extremely high energy impact, patients may need to adhere to toetouch weight bearing regimen for 10–12 weeks.2 On the other hand, a survey about the adherence of current RWB protocols showed that almost 90% of the surgeons do not follow these protocols standardly regarding the weight bearing aftercare for tibial plateau fractures.19 In addition, there is currently no consensus among surgeons worldwide with regard to early weight bearing versus restricted weight bearing in surgically treated trauma patients with fractures of the tibial plateau.19,25 High-quality clinical studies about early or permissive weight bearing (PWB) are scarce. Furthermore, to our knowledge there have been no studies on permissive weight bearing and its complications during rehabilitation from (peri)- or intra-articular fractures of the pelvis and lower extremities treated with internal fixation. Recent

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